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Ependymoma

Open Table of Contents: Ependymoma

Figure 1: Axial and sagittal T2 (top row left and bottom row left) and sagittal T1 post-contrast fat-saturated (FS) images (top row right) demonstrate a centrally located enhancing lesion which expands the upper thoracic spinal cord. The non-enhancing region of T2 hyperintensity in the cranial aspect of the lesion likely represents a polar cyst (also known as a peritumoral or satellite cyst).

Figure 1: Axial and sagittal T2 (top row left and bottom row left) and sagittal T1 post-contrast fat-saturated (FS) images (top row right) demonstrate a centrally located enhancing lesion which expands the upper thoracic spinal cord. The non-enhancing region of T2 hyperintensity in the cranial aspect of the lesion likely represents a polar cyst (also known as a peritumoral or satellite cyst).

Clinical Features

  • Age groups: Adults (3rd to 5th decades of life) > Children (exception: NF-2)
  • Gender: M > F
  • Presentation: Neck or back pain
  • Associations: NF-2
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Imaging

  • General:
    • Location:
      • Cervical > Thoracic
      • Central > Eccentric location within the cord (arises from ependymal lining of central canal)
    • Appearance:
      • On average 3.5 vertebral bodies in length
      • Peritumoral or non-tumoral cysts more common than tumoral cysts
        • Peritumoral/polar/satellite cysts: Form from egress of fluid from the tumor into the spinal canal. Are not part of tumor and commonly involute following resection of solid mass.
      • Hemorrhage more common than with astrocytoma
  • Modality-Specific:
    • Radiography:
      • Can see scalloping of dorsal aspects of the vertebral bodies
    • CT Myelography:
      • Spinal cord not well evaluated. May see spinal cord swelling.
    • MRI:
      • T1: Isointense or hypointense.
      • T1 + Contrast: Solid enhancement > heterogeneous enhancement
      • T2: Hyperintense. May see peritumoral cysts with T2 hypointense “hemosiderin cap”
      • STIR: Hyperintense
      • DWI: Restricted diffusion

Contributor: Jacob A. Eitel, MD

DOI: https://doi.org/10.18791/nsatlas.v1.04.02.02

References

“A Pattern Approach to the Differential Diagnosis of Intramedullary Spinal Cord Lesions on MR Imaging" : American Journal of Roentgenology : Vol. 170, No. 6 (AJR).

Koeller, Kelly K., R. Scott Rosenblum, and Alan L. Morrison. “Neoplasms of the Spinal Cord and Filum Terminale: Radiologic-Pathologic Correlation.”RadioGraphics20, no. 6 (November 1, 2000): 1721–49.

Jeffrey S. Ross MD, and Kevin R. Moore MD. Diagnostic Imaging: Spine, 3e. 3 edition. Philadelphia: Elsevier, 2015.

Smith, Alice Boyd, Karl A. Soderlund, Elisabeth J. Rushing, and James G. Smirniotopolous. “Radiologic-Pathologic Correlation of Pediatric and Adolescent Spinal Neoplasms: Part 1, Intramedullary Spinal Neoplasms.” American Journal of Roentgenology 198, no. 1 (January 1, 2012): 34–43.

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